ACC Justice and Mental Health Collaborative Planning ... · ACC Justice and Mental Health...
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ACC Justice and Mental Health Collaborative Planning Initiative FY 2016
Statement of the Problem
For years, the prevalence of mentally ill individuals frequenting our jail and hospital
emergency rooms has been the subject of concern of a vocal minority of key stakeholders within
our local government infrastructure. The need was first articulated during the development
process of our first mental health treatment and accountability court in 2006. Since then, largely
informal discussion have occurred sporadically until Interim Chief of Police Carter Greene
formed a group earlier this year with the assistance of Superior Court Judge David Sweat with
the mission of creatively developing specific protocols and procedures for the purpose of
diverting individuals with mental illness from the local jail and hospital emergency rooms. The
table below illustrates the leadership and key stakeholders who have committed their time and
resources to the successful development and implementation of this plan:
Leader / Stakeholder Representing Organization / Service Area
Chief Carter Greene (Interim) Athens-Clarke County Police Department
Honorable David A. Sweat Athens-Clarke County Superior Court
Chief Tommy York Athens-Clarke County Jail
Oliver J. Booker, CEO Advantage Behavioral Health Systems
John Reeck, Director of Emergency Services St. Mary’s Hospital
Gale Kinder, Director of Emergency Services Athens Regional Medical Center
David Cogdell, Director Benchmark Human Services
Don Cargile, Regional Coordinator National Emergency Management Services
Janet Rechtman, Senior Public Service
Associate
UGA Fanning Institute
Delene Porter, President/CEO Athens Area Community Foundation
It is a well-known fact that the local justice system, mental health system, and local
hospital emergency rooms often share the same population of individuals with mental illness
and/or co-occurring substance abuse disorders. The costs associated with this population of
“frequent flyers” has spurred local interest in developing measures to more effectively divert
them to more cost appropriate and rehabilitative treatment options. Our current system is
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fragmented. Interdepartmental communication breakdowns have contributed to those in need not
effectively directed toward recovery. The intention of conducting this thorough planning and
policy implementation process will result in developing the institutional infrastructure to allow
for the development of programs that effectively respond to the needs of the mentally ill by
providing immediate access to state of the art treatment and support se rvices within the
community.
Athens-Clarke County Police Department provides ongoing Crisis Intervention Training
and annual In Service Training as a requirement to all patrol officers to better prepare them in
making assessments and determinations to the mental health needs of individuals involved in a
call for service. It can be safely assumed that every key organization involved in this system of
care is properly trained to deal with an individual in crisis. However, there are certainly
organizational silos that deter a smooth and efficient process. When a person in mental health
crisis (PMHC) is i nvolved with our system, the parties involved include hospital ER staff, local
EMT, mental health provider, and crisis stabilization when available. There currently exist
informal and largely unwritten rules for communication and coordination protocols among these
different entities that can sometimes result in inefficient systems of coordinated care. To
paraphrase the Chief Jail Commander, Tommy York: “We need to develop solutions that are
driven by the needs of the specific mental health consumer that comes into contact with our
criminal justice system, rather than by the limited mission and financial constraints of the
participating partners in order to divert these individuals from confinement.”
As part of the early planning for this grant proposal, pre liminary internal analyses
conducted by local justice system and area hospitals revealed substantial costs associated with
repeatedly dealing with these individuals. In 2014, Police responded to over 6,000 calls for
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service involving individuals with mental health concerns. Area hospital emergency rooms
reported over 2,500 emergency room visit related to mental illness with an estimated reported
cost of slightly over $2 million. The Athens-Clarke County Jail currently operates with an
average population of 460 inmates, 25% of which are, on average, on medication for mental
health related symptoms.
Athens-Clarke County is committed to the pursuit of alternatives to incarceration and has
served as a leader in the state by establishing five accountability courts, a pre-trial release
program, intensive supervision through electronic monitoring, and a state-of-the-art work release
center. In 2001, a Justice System Needs Assessment was ordered by the ACCUG to directly
address the need to reduce demand for jail beds. The primary objective of this study was to
examine the efficiency of the system resulting in incarceration and jail population along with
alternative sanctions or programs to reduce the current and forecasted demand. In 2003, the
results of the two year study were published. The estimated jail bed demand given current
conditions was estimated at 850 beds by 2016 and at least 950 beds by 2021. The current
capacity of the Athens-Clarke Clarke County Jail in 2015 is 494. A new jail is currently under
construction that will have a capacity of 750 inmates. Many recommendations from the study,
all of which have proven to be positive alternatives to incarceration, have been developed, fully
funded and implemented, including the following:
Solicitor General’s Pretrial Release Program: Solicitor General’s Pre-trial Release Program
was initiated with the help of several law enforcement offices within the ACCUG in March
2011. Goals of the pretrial release program include a reduction in jail overcrowding. The
program allows defendants to maintain family obligations, school, and jobs; and enhances public
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safety by providing a significant amount of supervision, which allows for a high level of
accountability, even though the offender is not incarcerated.
Accountability Courts: Athens-Clarke County has established five accountability courts that
currently serve approximately 170 non-violent offenders. The goal of accountability courts is to
serve as an alternative to incarceration by providing a rigid and successful treatment program
that maintains high levels of participant accountability. Participants in these programs, upon
successful completion and graduation, typically receive reductions in their sentences, lower
fines, and other incentives.
Project Design and Implementation
ACC Police Department will contract with the UGA J. W. Fanning Institute for
Leadership Development to facilitate the planning process and with the Carl Vinson Institute of
Government for data collection and to evaluate performance and outcomes of this effort. The
process will involve an extensive network of community stakeholders beyond the
aforementioned initiative leaders to include frontline workers in the local jail, police force,
hospitals, and local homeless service provider organizations. Established networks such as the
Athens Homeless & Poverty Coalition and the Athens Health Network have expressed verbal
interest in this effort and provide immediate access to these stakeholders. With the involvement
of these partners, we project that at the end of the two year planning period, this initiative will
create a clearly defined plan for increasing crisis response capacity to divert individuals with
mental health and co-occurring substance abuse issues from jail. In addition, we expect that
there will be additional outcomes of network development, indicated by consistent participation
by key players, maximum connectivity, and optimal information sharing within the network.
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We propose a step-by-step framework to facilitate the planning process. This framework differs
from the customary planning approach in that it creates feedback and decision-making loops for
key stakeholders and management; in effect it builds a platform for evaluation as part of the
planning process. This approach provides partners with baseline and summary data regarding
the current state, potential future impact and high priority measures of success. Each partner can
use this information to inform strategic decisions about their own activities as well as to define
mutually beneficial opportunities to create collective impact.
DETAILED PLAN OF WOR K
Phase 1: Environmental Scan – 2 months
The following steps will aid in formalizing the team of county leaders and decision-makers as
well as clarify and document how individuals with mental disorders move through the local
justice system to inform phase 2.
1. Review of Historic Documents Foundational documents for
each partner
Federal and state expectations
Comparable benchmarks
Review of related literature and
research
2. Community Context Interviews with leadership and
key external stakeholders
Focus group(s) of consumers
Collaborative capacity and
performance assessment
3. Collaborative Partner Interviews Review of program inputs
Identify sources and uses of
funds
Analysis of system structure,
and board activities.
4. Demographic Profiles GIS Mapping and Analysis
Socio-economic data gathering
of related issues in region
Analysis of system costs related
to population
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5. Baselines for policies and procedures
currently in use
Comparative analysis of
policies and procedures at local
(including corporate), state, and
federal levels
Documentation of baseline
costs, revenues, and activities at
all stages of the encounter
between Persons in Mental
Health Crisis (PMHC) in ACC.
Phase 2: Vision and Goal Setting – 20 months
The following a ctivities will facilitate the ACC collaborative development along with their
vision and goals:
Analysis of Client Flow through the Crisis Response System: This analysis will begin
with constructing a flow diagram that identifies the existing entities, individuals and
organizations in the community who help manage the response, care and flow of the
person-in-mental-health-crisis (PMHC). Our initial overview and intimate knowledge of
the process suggest that the system of PMHC care in Athens-Clarke County currently
includes:
Person in Mental Health Crisis (PMHC) – these individuals self-identify, and/or
are in the presence of family members, co-workers, community workers and other
local care givers, police and firemen, EMC staff, and medical staff and/or the
general public.
Emergency Information and Referral Contacts – this includes 911 operators, crisis
or suicide hotlines, primary care phsysicians, and other sources of information
and referral for individuals in mental health crisis that are a danger to themselves,
family, friends, co-workers and/or the general public.
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First Responders – this includes police officers, fire department personnel, private
and public EMS providers, mental health crisis responders, and others that can
assess the level of emergency and the mental state of the perspective client.
Admission and Intake Specialists – this includes correctional officials managing
the space in local jails, hospital intake and medical staff, DFCS (depending on
social circumstances of the PMHC), and Crisis Stabilization Units (CSU) staff
members.
Alternative Diversion Treatment Facilities - this includes facilities that have
missions specifically focused on caring for the mentally ill and are therefore
uniquely different from hospitals, emergency care units that primarily focus on
medical issues other than mental health and jails that are primarily focused on
housing those with criminal behavior; these alternative diversion options may
expand the local capacity to care for PMHC; this option maybe underutilized
currently.
Family Members, Care Givers and Others outside of the medical and correctional
system that have the capacity and willingness to care for the individual in crisis.
This analysis will yield a system level view of the dynamic interactions that occur when
an individual who requires emergency assistance for mental health services enters the system and
a clear picture of the contributions and costs for each actor in the system, called a value chain.
To amplify, the term “PMHC Value Chain” helps maintain our overall focus on how much
“value” each entity noted brings to how the client is received, treated and eventually released as
appropriate. This business-like approach is consistent with the emerging focus on evidence-based
practices that assess the effectiveness of non-profits and social services that do good work but
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benefit from a business perspective of their individual and collaborative services. As we progress
through our analysis, we expect to better quantify how each key player in the chain adds value to
how the PMHC is managed. We will then be in a better position to determine how a revised flow
may bring more efficiency to the system and result in overall cost savings without negatively
impacting the quality of care provided to the PMHC.
Assessment of Policies and Procedures Associated with the Emergency Mental
Health Care System: Once the key players are identified, we will take a detailed look
and analysis of the policies and procedures of each player in the PMHC Value Chain.
This examination is an intensive component of the planning phase and will include:
Review of all relevant documents available from key players identified above to
better understand both the in-practice and in-theory policies and procedures that
apply to the pro cess of managing the care of PMHC
Interviews of policy makers and decision makers to clarify how their policies and
procedures add to the effective and efficient handling of the PMHC, noting
opportunities for revisions and changes that portend improved efficiencies
without negative impact on the perspective client
Focus groups with stakeholders who are the friends, family and associates of the
PMHC and can provide independent insight into the efficiencies and effectiveness
of the system which has provided services (or not provided services) to PMHC,
noting:
o response time o adequacy of trained personnel o personal cost and system cost (perceived and real) o gaps in services
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o outcomes from the perspective of the PMHC and others connected to the client
Definition of collaborative Action Plan and Cost Analysis of System to
Identify Opportunities for System Improvement: Once the analytical step is
complete, we will continue to work with each of the key players to develop an
action plan that embraces a revised approach to how the county provides needed
services to PMHC.
In this step we will also develop metrics to identify costs associated with each phase of
the systems of managing the assessment, care, and intake of PMHC. Specific attention will be
given to service gaps, overlaps and duplications, labor intensive procedures and policies that are
barriers to cost savings and lead to automation and elimination. Importantly, the metrics
developed here will also be part of the Evaluation Plan. Additionally, this stage will include a
review and analysis of statewide standards and policies and best practices from comparable
counties. We will integrate the outcomes of those reviews into the final stage below.
Phase 3: Refining the Plan – 2 Months
Recommendations and Conclusions: We will use the information from the above steps to
develop a set of recommendations that minimize resources without negative impact on the
client. We will focus especially on cost saving and efficiencies that will make this county a
model of performance in how it provides timely and effective service to PMHC.
Scenario Planning to Set Priorities for the Revised System of Care for PMHC: With the
cooperation and collaboration of the key players identified above, we will test the
effectiveness and efficiencies of any revisions suggested from our analysis and review. The
scenarios will include pro-forma budgets for startup and operation over a 3-5 year span.
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Phase 4: Summation and Next Steps
Project Impact: Summary of project accomplishments based on process outlined above
and specific goals that emerge from this work and articulation of evaluation framework
and baseline for implementation.
Final Plan: Preparation of three versions of the final report: Executive Summary, Full
Report and a PowerPoint presentation suitable for general audiences.
Capabilities and Competencies
The J.W. Fanning Institute for Leadership Development – a unit of Public Service and Outreach
at the University of Georgia – is dedicated to strengthening communities, organizations, and
individuals through leadership development, training, and education. Founded in 1982, the
Institute is named for UGA's first Vice President for Services, Dr. J.W. Fanning. His legacy of
leadership development is embodied in the Institute's dedication to developing leaders of all
ages, in every community, from all walks of life. A variety of clients call on the Institute's multi-
disciplinary faculty for their expertise in community, non-profit, organizational, and youth
leadership development.
Lead Staff:
(b)(6) Ph.D. is co-lead of Fanning’s nonprofit leadership and capacity building
services. She joined Fanning in 2008 as a Senior Fellow after a successful career as an
entrepreneur in the fields of marketing, employee communications and nonprofit consulting. (b)(6)
(b)(6) has facilitated strategic planning and implementation for more than one hundred
nonprofit, government and faith based organizations. (b)(6) received her BA from
Emory University, a Masters from York University/University of Toronto and a Ph.D. from
Antioch University where her doctoral research was about the leadership experience of nonprofit
executive directors.
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(b)(6) Ph.D. works in the area of community leadership with a focus on promoting
entrepreneurial and servant leadership. With more than three decades of academic and business
experience, he is an expert in developing leadership and entrepreneurship curriculum and
facilitating leadership development workshops and courses.
(b)(6) Ph.D. has more than 10 years of professional experience and a background in
leadership development with an extensive knowledge of Georgia and its needs; in particular, how
the changes in demographics impact the design, outreach and delivery of programs and
initiatives across multiple communities in Georgia. In addition, she designs, promotes, and
conducts training for nonprofits and works in the areas of program assessment and evaluation,
strategic planning, and capacity building.
(b)(6) M.S.W. is a Public Service and Outreach Graduate Fellow at Fanning, working
with the nonprofit leadership and capacity building services. She has twenty years of nonprofit
leadership experience in program development, evaluation, and board governance. (b)(6)
received her B.A. from Clark University, a Masters in Social Work from the University of
Georgia, and is currently a doctoral student in Public Administration and Policy at the University
of Georgia.
Our goal is to adopt system wide protocols that will maximize resources and more efficiently
move these individuals through our system of care. The team has developed a theory of change
that addressed five unique concepts:
1. The driving measurable impact of this effort will be to ultimately reduce and divert the
number of individuals with mental health concerns from our local jail and hospital
emergency rooms.
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2. We have developed a multidisciplinary team including the Clarke County Police
Department, Sherriff’s Office, our two area hospitals, the local behavioral health
provider, the local court system, and ambulance service.
3. This team has identified specific barriers to be addressed which include: lack of local and
state funding support for staff and receiving center operational funding, breakdowns in
interdepartmental communication within the context of crisis response, and limited
training opportunities for direct responders to individuals in crisis.
4. The assets we do have ultimately come from the interests and willingness of leadership
from the team partners to come together and pursue the development of a successful
diversion program
5. The team identified several key strategies integral in accomplishing the main objective of
diversion and ultimately local cost savings.
The graphic below outlines the planning process that will be implemented to direct local policy
decisions:
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While the goal of developing a seamless integrated system among all key partners responding to
an individual in crisis seems ideal, there are several institutional and cultural barriers that need to
be overcome in order to establish partner, and ultimately, community buy-in. The chart below
outlines the anticipated barriers and how we hope to overcome them:
Anticipated Barrier Proposed Solution
1. Lack of local persuasive data indicating
the extent and prevalence of need
within this community
The team will partner with a third party
consulting firm, the UGA Fanning Institute,
which has demonstrated experience in data
collection and analysis as well as a pre-existing
knowledge of the local community.
2. Policies governing privacy and the
sharing of consumer information vary
between the organizational partners
Thorough analysis of each organizations
existing policies and procedures within the
context of privacy will encourage an open
discussion of how to address these issues and
develop formal processes for releases of
consumer information.
3. While network partners likely can
develop a common mission, they will
have different oversight and regulatory
bodies, precluding consistently shared
objectives at the program or service
level
Develop a long-range planning approach;
define phases of development and identify
goals and objectives of each phase. Support
network members in staying focused on long-
range goals while recognizing and
acknowledging incremental successes.
4. Innate cultural differences and
organizational values can also inhibit
the development of policies and
protocols shared consistently by each
partner agency.
Anticipate major impasses; create a work
group strategy to address and eventually
resolve impasses. Keep communication lines
open at all levels of the planning process.
Data Collection Plan
The J.W. Fanning Institute will be responsible for facilitating and directing the planning process
for this initiative and will be complemented by the Carl Vinson Institute for Government to
design the formative evaluation. This brings a comprehensive approach to facilitation and the
ability to link up with state policy makers so that efforts for implementation will be aligned with
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the statewide resource mix, with statewide policy and with the various governance structures in
the criminal justice and mental health/substance abuse treatment systems. Collaborative
planning helps members of the network create a theory of change that informs decisions
regarding resource allocation, staffing, collaboration and strategic planning. Collaborative
evaluation shows members of the network understand how their theory of change relates to
actual experience. Although these processes are independently conducted, they are developed
simultaneously to ensure cohesion. The following figure depicts this relationship:
Measuring Program Success & Sustainability
Underlying this entire planning process is the goal of establishing substantial and committed
financial buy-in from local, state and federal entities for the development of a tangible solution
that will directly achieve the operational outcomes created through this planning process.
Through the completion of a comprehensive and detailed data driven analysis of the extent and
prevalence of individuals with mental illness accessing services in cost burdened systems, we
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intend to demonstrate the real cost savings that will result in the diversion of these individuals
into a mental health receiving center dedicated to this specific population.
The chart below outlines the data collection and evaluation process that will continuously inform
planning process moving forward and ultimately determine the overall sustainability of this
effort:
Evaluation Question Analytical Evaluation
Activities
Data Collection and Reporting
1. To what extent did planning
activities match original
plan? (Includes adherence
to timeline, budget, and
responsible parties)
Quarterly discussions with
Network members.
Surveys and focus group
sessions to coincide with
ongoing strategic planning
activities.
Data collection is ongoing with quarterly
reports to network partners and meetings
with other stakeholders as needed.
Interviews/focus groups mid-year and end
of year. Included in semi-annual and end
of the year reports 2. What were the changes and
reason for any changes
made to the original plan?
3. How effective were
changes made in original
plans?
4. To what extent did
contextual variables change
from those considered in
the original proposal?
5. How can planning activities
be improved?
Ongoing SWOT Analysis Mid-year and end of the year. Included in
semi-annual and end of the year reports.
6. How many successful,
formal partnerships with
team members were
created?
Review of continuous
development of Partner MOUs.
7. What planning/contextual
factors were associated with
the program outcomes?
Analysis of the extent to which
planning activities coincided
with the accomplishment of
program outcomes.
8. How can the planning
activities be expanded to
other areas?
Analysis of planning activities
in common with other network
developments
Analysis conducted on a quarterly basis.
9. How sustainable are the
network planning activities?
Analysis of team members’
organizational capacity and
willingness to share resources.
End of year review and included in year-
end reports
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